Form Driver Form 5 Driver Form 5 Weekly Phone Briefings

OMB NO: XXXX-XXXX

Expiration Date: mm/dd/yyyy

Participant ID: _________

Flexible Sleeper Berth – Weekly Check-In

Document nature of all contact between subject and research team (indicate date/time for each event).

DRIVER PARTICIPATION WEEK: ___________

Dates: ____ /____ /____ – ____ /____ /____

Weekly ELD Data Reviewed? _______

Notes: ____________________________________________________________________________________

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Actigraphy Data Reviewed

Day 1 _____ Day 2 _____ Day 3 _____ Day 4 _____ Day 5 _____ Day 6 _____ Day 7 _____

Notes: ____________________________________________________________________________________

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Smartphone Data Reviewed

Day 1 _____ Day 2 _____ Day 3 _____ Day 4 _____ Day 5 _____ Day 6 _____ Day 7 _____

Notes: ____________________________________________________________________________________

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Phone Contact Date/Time ____ /____ /____ _____:_____

Contact RA: _____________

Number of days on duty in the last 7 days? _______

Number of days using sleeper berth this week? _______ Not using sleeper berth? _______

If not using sleeper berth, why: __________________________________________________________

Did you have any truck breakdowns this week? ___________________________________________________

Did you take any vacation days this week? _______________________________________________________

On how many duty days this week did you spend 10 or more consecutive hours of rest in your sleeper berth, compliant with the current HOS sleeper berth regulations? _______

On how many duty days this week did you spend 8 or more consecutive hours of rest in your sleeper berth with an additional 2 hours off duty, compliant with the 8+2 rule? _______

On how many duty days this week did you split your sleep, spending two rest periods in your sleeper berth, of at least 3 hours each and together totaling at least 10 hours, compliant with the flexible sleeper berth study allowance? _______

Did you wear the actigraph at all times (even while sleeping)? ___________________________________

Did anyone else drive your truck? __________________________________________________________

Did you have trouble with any of the study equipment this week? ________________________

Do you have any questions regarding the study or procedures? ________________________

Did anyone other than you use your smartphone, actigraph, or other study equipment? _________

If so, approximate date/time? _________________

When did you last sync and charge your actigraph? ________________________

When did you last charge your study smartphone? ________________________

Notes:____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Compliance issues noted by RA: _____________________________________________________________

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Notify Dr. Honn of compliance issues. These include, but are not limited to:

• Failure to meet the required minimum 10h total of rest time per duty period (by ELD or self-report), either through: 10h consolidated SB time, split SB totaling 10h, or 8+2 rule

• Extended (>1h) or undocumented removal of actigraph, other than for the purpose of charging

• Failure to complete 3 PVTs per day (4 when using flexible SB allowance)

• Failure to complete smartphone sleep/wake log

• No sleeper berth use documented in the past 7 days

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